The appropriate cone depth to avoid endocervical margin involvement is dependent on age and disease severity

Bae, Hyo Sook; Chung, Youn Wook; Kim, T.; Lee, Kyu Wan; Song, Jae Yun

doi:10.1111/aogs.12025

Cited by 27 publications

(37 citation statements)

References 21 publications

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“…In 2011, the IFCPC reported the definition of cone length as the distance from the distal or external margin to the proximal or internal margin of the excised specimen [ 13 ]. We found several studies which analyzed optimal cone length to avoid positive cone margin, but most of them analyzed cone depth rather than cone length [ 15 16 ]. Milinovic et al [ 17 ] reported the appropriate length of conizaiton as 18 mm in multiparous and 15 mm in nulliparous patients to secure a negative margin status, and that was the only study which analyzed appropriate cone length for CIN.…”

Section: Discussionmentioning

confidence: 99%

“…In practice, we design conization according to colposcopic findings such as type of transformation zone (TZ) [ 13 14 ] and position of the lesion. Several studies reported on appropriate cone depth [ 15 16 ], but we found only one small study which reported appropriate cone length to avoid positive cone margin. This study examined the risk factors of positive cone margin and identified the appropriate cone length necessary to avoid positive cone margin.…”

Section: Introductionmentioning

confidence: 88%

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Identification of appropriate cone length to avoid positive cone margin in high grade cervical intraepithelial neoplasia

et al. 2016

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ObjectiveTo identify key factors for predicting positive cone margin and appropriate cone length.MethodsWe retrospectively reviewed the margin status of patients who received conization with high grade cervical intraepithelial neoplasia, along with other factors such as patient age, parity, preoperative cytology, size of disease, type of transformation zone, and cone length from patient records. Cut-off value of cone length was analyzed in women younger than 40 years old because we design conization with minimum length especially for women who wish for future pregnancy. Cut-off value of cone length was defined as length corresponds to estimated probability of positive cone margin equal to 0.1 by logistic regression analysis with variables selected by stepwise methods.ResultsAmong 300 patients, 75 patients had positive cone margin. Multivariable analysis revealed that squamous cell carcinoma at preoperative cytology (p=0.001), 2 or more quadrant disease (p=0.011), and shorter cone length (p<0.001) were risk factors for positive cone margin. Stepwise methods identified cone length and size of lesion as important variables. With this condition, cut-off value of cone length was estimated as 15 mm in single quadrant disease and 20 mm in 2 or more quadrant disease, respectively.ConclusionWe identified the independent risk factors of positive cone margin and identified the cut-off value of cone length to avoid positive cone margin in women younger than 40 years old. Conization should be performed not only according to colposcopic findings including type of transformation zone but size of disease and cone length.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 88%

Identification of appropriate cone length to avoid positive cone margin in high grade cervical intraepithelial neoplasia

et al. 2016

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“…In addition to the technique itself, margin involvement was found to be associated with the patient's age and menopause status in the present study. Some studies have confirmed the relationship between age and endocervical margin but not the relationship between age and ectosurgical margin[ 18 , 19 ]. Bae et al reported that the risk of endocervical margin involvement increases with the age (the odd ratios were 1.59 for 40– to 59-year-old patients and 4.16 in patients over 60 years compared to patients younger than 40 years) [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have confirmed the relationship between age and endocervical margin but not the relationship between age and ectosurgical margin[ 18 , 19 ]. Bae et al reported that the risk of endocervical margin involvement increases with the age (the odd ratios were 1.59 for 40– to 59-year-old patients and 4.16 in patients over 60 years compared to patients younger than 40 years) [ 18 ]. This finding might be due to the migration of the transformation zone to the cervical canal with the age and following menopause, which leads to difficulties in removing the intact transformation zone in elderly and postmenopausal women.…”

Section: Discussionmentioning

confidence: 99%

Conization Using an Electrosurgical Knife for Cervical Intraepithelial Neoplasia and Microinvasive Carcinoma

Xiang

Yang

et al. 2015

PLoS ONE

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ObjectiveThe aim of the present study was to evaluate the incidences of margin involvement, disease relapse, and complications in patients who had undergone conization using an electrosurgical knife (EKC) for cervical intraepithelial neoplasia (CIN) or microinvasive carcinomas (micro-CAs).Materials and MethodsA retrospective case series analysis was performed with a total of 1359 patients who underwent EKC in Fudan University Shanghai Cancer Center between June 2004 and July 2010.ResultsThe median age of the patients was 39 years old (range: 19-72). Conization revealed the presence of CIN in 1113 (81.9%) patients, micro-CA in 72 (5.3%) patients and invasive carcinomas in 44 (3.2%) patients. The remaining 130 (9.6%) patients were free of diseases in the cone specimens. Positive surgical margins, or endocervical curettages (ECCs) were found in 90 (7.6%) patients with CINs or micro-CAs. Three factors were associated with positive margins and ECCs and included age (>50 years; odds ratio (OR), 3.0, P<0.01), postmenopausal status (OR, 3.1, P<0.01) and microinvasive disease (OR, 2.7, P<0.01). One thousand and eighty-nine (92.0%) patients were followed-up regularly for a median follow-up duration of 46 months (range: 24-106 months). Disease relapse was documented in 50 (4.6%) patients. Eighty-two (6.0%) cases experienced surgical complications that needed to be addressed, including early or late hemorrhages, infections, cervical stenosis, etc.ConclusionsOur patients demonstrated that EKC was an alternative technique for diagnosis and treatment of CIN or micro-CAs with relatively low rate of recurrence and acceptable rate of complications. A randomized clinical trial is warranted to compare EKC, CKC and LEEP in the management of CIN or micro-CA.

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“…A pre-surgical variable that was found to be associated with endocervical cone margin status in this study was age. Many previous studies in the literature have reported increasing age as a risk factor for positive surgical cone margins [11,13,19,20]. This association is mainly due to the more frequent presence of a type 3 transformation zone in this population.…”

Section: Variablesmentioning

confidence: 74%

What is the value of pre-surgical variables in addition to cone dimensions in predicting cone margin status?

Giannella

Giuseppe

Prandi

et al. 2020

European Journal of Obstetrics & Gynecology and Reproductiv

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The appropriate cone depth to avoid endocervical margin involvement is dependent on age and disease severity

Abstract: Age, disease severity and cone depth are predictive factors for endocervical margin involvement. In women of reproductive age, the appropriate cone depth to avoid endocervical margin involvement can be changed depending on age and disease severity.

Cited by 27 publications

References 21 publications

Identification of appropriate cone length to avoid positive cone margin in high grade cervical intraepithelial neoplasia

Identification of appropriate cone length to avoid positive cone margin in high grade cervical intraepithelial neoplasia

Conization Using an Electrosurgical Knife for Cervical Intraepithelial Neoplasia and Microinvasive Carcinoma

What is the value of pre-surgical variables in addition to cone dimensions in predicting cone margin status?

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